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Hepatitis

Overview of hepatitis

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as A, B, C, D and E. Hepatitis A is an acute disease, while hepatitis B and C viruses have a chronic course and are likely to result in complications such as hepatic (liver) cancer and cirrhosis.1

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids (such as from blood transfusions). Hepatitis B is also transmitted by sexual contact.

Clinical presentation of hepatitis varies from individual to individual and with the etiology of infection. Some patients may remain entirely asymptomatic, whereas others may present with rapid onset of fulminant hepatic failure. There is no specific treatment for acute infection. The management of chronic cases is discussed on individual topics.

Hepatitis A

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. This disease is caused by the hepatitis A virus (HAV), and is closely associated with inadequate sanitation and poor personal hygiene. Worldwide, HAV infections account for an estimated 1.4 million cases annually.2

Clinical Features (Symptoms of hepatitis A)

The symptoms of hepatitis A usually develop between 2 and 6 weeks after infection. The symptoms range from mild-to-severe and sometimes may go unnoticed. The common symptoms are nausea, fever, malaise, loss of appetite, jaundice, diarrhea, abdominal discomfort and dark-colored urine.

The clinical features are more pronounced in the adults than children. Children under six years of age do not usually experience noticeable symptoms and only 10% develop jaundice. Most people recover in several weeks or sometimes months without complications. Chronic infection with HAV does not occur.

Treatment and Prevention hepatitis A

There is no specific treatment for hepatitis A. Management is aimed at maintaining adequate nutritional balance, including replacement of fluids and electrolytes. The disease is preventable through improved sanitation and hepatitis A immunization. Personal hygiene practices such as frequent hand washing, adequate supplies of safe-drinking water and proper sewage disposal reduce the spread of HAV.

Hepatitis A vaccine is recommended to all children older than 2 years who live in or travel to places where HAV infections is unusually high or where there are periodic outbreaks of hepatitis A. The protective levels of antibodies to the virus develop within one month after a single dose of the vaccine.

Hepatitis A

Vaccine for hepatitis A

Hepatitis B

Hepatitis B is a serious and common infectious disease of the liver caused by the hepatitis B virus (HBV). It is transmitted through activities involving contact with blood or blood-fluids such as unprotected sex with an HBV-infected person, share of intravenous needles and blood transfusions that have not been screened for HBV.

Hepatitis B virus infection is the 10th leading cause of death worldwide. Of approximately 2 billion people who have been infected, more than 350 million are chronic carriers of HBV. Almost 15–40% of HBV-infected patients will develop cirrhosis, liver failure or hepatocellular carcinoma.3

Clinical Features (Symptoms of hepatitis B)

The incubation period for HBV ranges from 6 weeks to 6 months. Clinical manifestations depend on the age at infection, the level of HBV replication and the host’s immune status. The signs and symptoms of acute infection include nausea, vomiting, malaise, abdominal pain, jaundice, dark urine and clay-colored stools. In addition, patients may develop skin rashes, joint pains and arthritis.

In chronic hepatitis, the affected individuals have biochemical or serologic evidence of continuing or relapsing hepatic disease for longer than 6 months with histologically documented liver inflammation. The clinical features vary with common symptoms such as fatigue, loss of appetite and occasional bouts of mild jaundice.

Treatment and Prevention of hepatitis B

No specific treatment has been available for acute HBV infection. Supportive and symptomatic care is the mainstay of therapy for most patients. Antiviral treatment reduces morbidity and mortality from chronic HBV infection. Conventional interferon alpha and lamivudine have been the primary antiviral treatment.

Safe injection techniques, effective treatments and mass immunization programs are essential for eliminating HBV and reducing global HBV-related morbidity and mortality. The implementation of mass immunization programs have been recommended by the WHO since 1991.4 Universal vaccination refers to the HBV vaccine administration to all infants as a part of the routine childhood immunization schedule and to all children younger than 11 or 12 years who have not previously received a vaccine.

Hepatitis B

Hepatitis C

Hepatitis C is caused by infection with the hepatitis C virus (HCV), which infects liver cells and can cause severe inflammation of the liver with long-term complications. Among those exposed to HCV, about 40% may recover completely, but the remaining patients become chronic carriers. Chronic hepatitis can be defined as a continuing disease without improvement for at least six months.

Chronic HCV infection is a worldwide public health problem with a global prevalence of 2–3%.5 Hepatitis C virus is the main reason for liver transplantation in the developed world and the main cause of liver-related morbidity and mortality in a number of countries. It is a frequent cause of chronic liver diseases such as hepatitis, cirrhosis and hepatocellular carcinoma. It is also implicated in the pathogenesis of various autoimmune and rheumatic disorders.5

Hepatitis C virus is transmitted primarily by blood and blood products, commonly by sharing infected needles with a carrier, from receiving infected blood and from accidental exposure to infected blood. Sexual transmission of HCV is less common than that of HBV and HIV. Perinatal transmission from mother to fetus is also possible, although uncommon. Many infected individuals have no obvious risk factors.

Clinical Features (symptoms of hepatitis C)

Symptoms of acute hepatitis C infection include nausea, vomiting, reduced appetite, fatigue, abdominal pain, jaundice and flu-like symptoms. Most patients with chronic hepatitis C will be asymptomatic or have nonspecific symptoms such as fatigue.

Management of hepatitis C

No specific treatment is available for acute HCV infection. The treatment that has shown the most promise in chronic hepatitis C is pegylated interferon alpha. This agent is often combined with an antiviral drug, ribavirin. Currently, there is no vaccine available against hepatitis C, as the virus comes in many forms and constantly mutates.

Hepatitis C

References

1.Van Bambeke F. The ABC of viral hepatitis. J Pharm Belg. 2008; 63(1): 15–20.

2.Hepatitis A. WHO, revised May 2008. Available at: http://www.who.int/mediacentre/factsheets/fs328/en/index.html Accessed on July 11, 2008.

3.Lok AS. Chronic hepatitis B. N Engl J Med. 2002; 346(22): 1682–1683.

4.Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat. 2004; 11(2): 97–107.

5.Antonelli A, Ferri C, Galeazzi M, Giannitti C, Manno D, et al. HCV infection: Pathogenesis, clinical manifestations and therapy. Clin Exp Rheumatol. 2008; 26(1 Suppl 48): S39–S47.

Written by: healthplus24.com team

Date last updated: December 31, 2014